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Invited Commentary
August 2013

Incisions and Esophagectomy: Is Surgical Approach All That Matters?

Author Affiliations
  • 1Section of Thoracic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
JAMA Surg. 2013;148(8):739. doi:10.1001/jamasurg.2013.2366

A variety of issues relating to the performance of esophagectomy have been fodder for lively discussion among thoracic surgical oncologists. These debates have focused largely on the effect on surgical outcomes of differences in operative technique (method of anastomosis or conduit choice for esophageal reconstruction) or approach (resection with or without thoracotomy, minimally invasive, or open).

Bhayani and colleagues,1 reporting in this issue, abstracted data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to address whether perioperative outcomes differ between patients undergoing transthoracic or transhiatal esophagectomy. In this study of 1568 patients for whom the surgical approach could be determined, transthoracic approaches were associated with increased rates of pulmonary complications and sepsis, but overall 30-day mortality and complication rates were similar in both cohorts. Within the transthoracic esophagectomy cohort, the authors also concluded that anastomotic leak rates did not differ between cervical and thoracic esophagogastric anastomoses. Because such procedure-specific complications were not monitored within the ACS NSQIP database, sepsis and organ-space infection were used as markers for this complication.